Effectiveness and safety of dupilumab in moderate‐to‐severe atopic dermatitis patients with chronic renal insufficiency: a real‐world retrospective study in China

Atopic dermatitis (AD) is a chronic, inflammatory, pruritic skin disorder with a complex etiology, 1 characterized by a T helper

tacrolimus and mycophenolate mofetil after kidney transplantation.Concomitant usage of low-to mid-potency topical corticosteroids and/or topical calcineurin inhibitors were permitted.The demographic and clinical characteristics of the patients were recorded.Disease severity and quality of life scores, including the SCORing atopic dermatitis (SCORAD), eczema area and severity index (EASI), investigator's global assessment (IGA), peak pruritus numerical rating scale (PP-NRS), dermatology life quality index (DLQI), and patient oriented eczema measure (POEM) scores, were assessed at baseline and 2, 4, 12, 16, 24, 52, and 104 weeks after the initial dose.The difference in disease severity scores and quality of life scores were compared by paired t-test or Wilcoxon signed-rank test at baseline and each time point after treatment.The primary endpoint was an improvement of at least 75% on the EASI (EASI-75).The secondary end point was an IGA score of 0 or 1 or an improvement of at least 4 points in the PP-NRS.
In our patients, percentages of achieving EASI-75, EASI-90 at week 16 are similar to those in a clinical trial 1 excluding patients with CRI (68.7 vs. 69.0%,31.2 vs. 40.0%,respectively), but the percentage of EASI-90 at week 52 in our patients is lower than that in clinical trial data (35.7 vs. 51.0%).It may be partly due to the discontinuation of dupilumab in our four patients before week 52.Interestingly, percentage of PP-NRS4 at week 16 in our patients (93.7%) is much higher than that reported in the clinical trial (59.0%). 1 The discrepancy between our study and others may be due to the concomitant CRI, race, age, and limited sample size, etc., which suggests that dupilumab may be beneficial for uremic pruritus.Pruritus is a common symptom associated with CRI, which causes are still unclear.Serum interleukin (IL)-31 is elevated in patients with uremic pruritus. 4In addition, IL-31 is positively correlated with the intensity of uremic pruritus. 4t is possible that dupilumab indirectly reduces pruritus by decreasing production of IL-31 by Th2 cells. 2 In case reports, dupilumab can successfully treat patients with severe uremic pruritus. 5In our patients, disease severity and quality of life significantly improved after dupilumab treatment and sustained for 104 weeks in AD patients with different stage of CKD (Table S1).Moreover, during this long follow-up period, dupilumab was well tolerated, neither adverse effects nor deterioration of renal function occurred.
This study has some limitations.First, this is a singlecenter, hospital-based study, which may have selective bias.Second, the sample size is limited.
This real-world study presents the results of a cohort of Chinese AD patients with CRI who used dupilumab.In conclusion, our findings suggest that dupilumab was successful at improving signs and symptoms and was as an efficacious and safe treatment option for AD patients accompanied by CRI.Further study with multicenter and larger samples is warrant to provide more evidence for dupilumab in AD patients with CRI.

A U T H O R C O N T R I B U T I O N S
Cong Peng, Qiaozhi Cao, and Feng Xiong wrote and revised the manuscript.Hui Xu diagnosed and classified CRI as well as the stage of CKD, revised the manuscript.Jie Li diagnosed and treat the patients, wrote and revised the manuscript.All authors have read and approved the final manuscript.